La enfermedad cardiovascular persiste como primera causa mundial de muerte en los adultos. La población de adultos jóvenes ha cursado con cambios en el estilo de vida con el paso de las décadas, favoreciendo la aparición de ateroesclerosis en etapas más tempranas y como consecuencia la aparición de eventos cardiovasculares de manera más prematura. Se ha identificado que dentro de los factores de riesgo más comunes, la mayoría de ellos son potencialmente modificables. En comparación con adultos mayores, se ha identificado con mayor prevalencia la presencia de etiologías no ateroescleróticas de infarto de miocardio, como la disección coronaria espontánea, alteraciones anatómicas, embolia y espasmo coronarios. Los hallazgos angiográficos y desenlaces son diferentes de acuerdo con el grupo de edad y el sexo. Por dicho motivo realizamos una búsqueda en PubMed de los estudios y registros publicados para el estudio del infarto agudo de miocardio en paciente jóvenes. Con dicha información realizamos la presente revisión con el objetivo de una mejor comprensión de los hallazgos comunes en este grupo y realizar su comparación con grupos de mayor edad.

Descripción demográfica y desenlaces de una red metropolitana de atención para el infarto agudo de miocardio

Cardiovascular disease is the leading cause of death in adults around the world. Young adult population has suffered changes in lifestyle over the decades, favoring the appearance of atherosclerosis at early ages, and as a consequence, the incidence of cardiovascular events emerges prematurely. It has been identified that most common risk factors are potentially modifiable. There is a greater prevalence of non-atherosclerotic etiologies of myocardial infarction such as spontaneous coronary dissection, congenital malformations, coronary embolism, and coronary spasm. Different angiographic findings and outcomes according to age and gender have been recognized. For this reason, we searched PubMed for published research and registries for the study of acute myocardial infarction in young patients. With this data, we carried out the present review to better understand the common findings in this group, and to compare them with older age groups.

Descripción demográfica y desenlaces de una red metropolitana de atención para el infarto agudo de miocardio

Funding Acknowledgements Type of funding sources: None. OnBehalf PHASE-MX Background Coronary artery ectasia (CAE), defined as "a dilatation greater than 1.5 times the diameter of the adjacent normal coronary arteries", is an uncommon finding in patients with acute coronary syndrome with a reported prevalence from 0.3 to 4.9% in different series. Because its low frequency, at present time there is lack of evidence and consensus of treatment strategies in those patients.  Purpose To identify differences in risk factors, treatment strategies and cardiovascular outcomes among population with and without CAE presented with STEMI.  Methods A retrospective, observational, comparative study was conducted in a tertiary-level cardiovascular center. We included hospitalized patients between 2018 and 2020 diagnosed with STEMI who had received reperfusion treatment within 12 hours of symptom onset. Coronary angiography was performed in the setting of primary PCI or pharmacoinvasive strategy. The primary composite endpoint was the time to first occurrence of either cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days of follow-up according to the presence or absence of coronary artery ectasia. Results We identified 539 patients with a STEMI diagnosis, of those 56 (10.3%) were diagnosed with CAE and 483 without CAE (89.7%). The median age of population was 57.9 (±10.9 SD) with no differences between groups and most of them were male (94.6% vs 85.7%, p 0.08). Among risk factors we identified a lower prevalence of type 2 diabetes mellitus in patients with CAE (14.2% vs 36.4%, p 0.001), no difference was observed in prevalence of hypertension (44.6% vs. 43.4%, p 0.86), obesity (26.7% vs 23.4%, p 0.57), dyslipidemia (26.7% vs 18.8%, p 0.35) or smoking (35.7% vs 45.1%, p 0.17).  In angiographic findings of patients diagnosed with CAE the infarction culprit artery had ectasia in 83.9% (n = 47) of the patients. According to the Markis classification, type 1 was the most common type, with the right coronary artery presenting the greatest involvement (72.7%, n= 40), followed by the anterior descending artery (67.2%, n= 37) and finally by circumflex artery (54.5%, n= 30). There were no differences in reperfusion strategies performed between both groups, pharmacoinvasive strategy (43.6% vs 50.6%, p 0.32) or PCI (56.4% VS 49.4%, P 0.12).  There was no difference in the primary composite endpoint of MACE over a period of 30 days of follow up (8.93% vs 10.3%, p 0.73) Figure 1. There was also no difference in major or minor bleeding between groups (5.4% vs 3.6%, p 0.78; and 3.5% vs 1.6%, p 0.37). Conclusion CAE is a disease with a higher prevalence in México than reported in other countries. There are no identifiable risk factors in our study that predicts the presence of CAE in patients diagnosed with STEMI.  Both reperfusion strategies used (Pharmacoinvasive strategy and primary PCI) could be safe with no differences in cardiovascular outcomes or bleeding at 1 month of follow-up. Abstract Figure.